HPV vaccination program brings dramatic turnaround
Genital warts have all but disappeared in young heterosexual Australians as the result of the national HPV (human papilloma virus) vaccination program, according to research based on surveillance data from the Melbourne Sexual Health Centre.
This dramatic turnaround within just four years points to the strong likelihood that HPV-related cancers will in future also become much rarer, according to the Melbourne School of Population and Global Health’s Professor Christopher Fairley. Professor Fairley is Director of both the Centre and School’s Sexual Health Unit, which is situated within the Centre.
“It is unprecedented for a sexually transmitted infection that is as common as genital warts to disappear so quickly,” Professor Fairley said. “The HPV vaccine program is pioneering for Australia and internationally – and no country in the world has seen a reduction in warts as dramatic as this.”
In a world first for a preventative health program targeting sexually transmitted infections (STIs), in April 2007 Australia began vaccinating young females aged 12 to 27 against HPV genotypes 6, 11, 16 and 18, using Gardasil. In a paper published in the British journal, Sexually Transmitted Infections, the study’s researchers reported that only four cases of genital warts occurred in women aged under 21 years from 1 July 2010 to 30 June 2011, compared with up to 66 cases per year before July 2007, the year the vaccination program started.
Comparing two 12-month periods of 2007-2008 and 2010-2011, the percentage of patients seen at the Melbourne Sexual Health Centre with genital warts declined in women aged under 21 from 18.6 per cent to 1.9 per cent. In heterosexual men aged under 21, genital warts declined from 22.9 per cent to 2.9 per cent.
Factors that contributed to the study’s results included access to very good surveillance data gathered by the centre, which saw 52,454 new patients between July 2004 and June 2011, Professor Fairley said. Australia also introduced the vaccine before other countries and achieved high vaccine coverage compared to other countries. “Some other countries introduced the vaccine for school age children but Australia was different in having a catch-up program up to age 26 in women. This meant a whole population of women between school age and 26 were offered the vaccine free of charge.”
Why was the vaccination program so effective? “It was well funded, well designed, well coordinated and it had broad public appeal,” he said. Its outstanding success had a range of significant health benefits. “Firstly, genital warts are already becoming a rare infection in young people. Genital warts are an unpleasant condition associated with significant morbidity. That result is terrific for young Australians,” he said.
“Because the vaccine has other strains in it, young women will no longer get nearly as many cervical abnormalities and so many fewer women will need treatment for abnormal pap smears. We’ve already seen a dramatic decline in women under 18 with high-grade abnormalities.
“Even more importantly but in the longer term, these results suggest the cancer-causing strains of HPV – that is 16 and 18 – will be rare in these young people. That means HPV-related cancers, including cervical cancer, vulval cancer, anal cancer, throat cancer and penile cancer, will become much less common over the next 20 to 30 years.”
Professor Fairley hopes to see the vaccine program extended to young men as well, with the aim of protecting gay men from the HPV-related cancers that affect them: anal cancer and throat cancer.
There was no chance that the vaccine’s success would dent business at the Melbourne Sexual Health Centre. “We have many more people coming here than we can deal with but it does mean the clinic is freed up to treat many others in need,” he said. “It’s a tremendous efficiency gain for sexual health services around the country.”